RESUMO
Flank pain caused by renal colic is a common presentation to emergency departments. This paper reviews the acute clinical assessment of these patients, outlines appropriate diagnostic strategies with labwork and imaging and updates the reader on conservative treatments, suitable choices for analgesia and indications for surgical intervention. Prompt diagnosis and appropriate treatment instituted in the Emergency Department can rapidly and effectively manage this excruciatingly painful condition.
Assuntos
Analgésicos/administração & dosagem , Diagnóstico por Imagem/métodos , Cólica Renal/diagnóstico , Cólica Renal/terapia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Tratamento de Emergência , Feminino , Seguimentos , Humanos , Cálculos Renais/complicações , Cálculos Renais/diagnóstico , Cálculos Renais/terapia , Masculino , Cólica Renal/etiologia , Medição de Risco , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
Renal cell carcinoma (RCC) and urothelial carcinoma of the upper urinary tract are not uncommon urological malignancies. Their simultaneous occurrence in a patient is, however, extraordinarily rare. We report the case of a patient who underwent laparoscopic nephrectomy for suspected RCC. Preoperative imaging was suspicious for renal pelvic involvement, which was confirmed upon bivalving the fresh specimen at the time of surgery, with the discovery of a separate urothelium-based lesion. We discuss this rare occurrence and our management approach.
RESUMO
OBJECTIVES: The purpose of this study was to measure interobserver reliability of 2 classification systems of pelvic ring fractures and to determine whether computed tomography (CT) improves reliability. The reliability of several radiographic findings was also tested. METHODS: Thirty patients taken from a database at a Level I trauma facility were reviewed. For each patient, 3 radiographs (AP pelvis, inlet, and outlet) and CT scans were available. Six different reviewers (pelvic and acetabular specialist, orthopaedic traumatologist, or orthopaedic trainee) classified the injury according to Young-Burgess and Tile classification systems after reviewing plain radiographs and then after CT scans. The Kappa coefficient was used to determine interobserver reliability of these classification systems before and after CT scan. RESULTS: For plain radiographs, overall Kappa values for the Young-Burgess and Tile classification systems were 0.72 and 0.30, respectively. For CT scan and plain radiographs, the overall Kappa values for the Young-Burgess and Tile classification systems were 0.63 and 0.33, respectively. The pelvis/acetabular surgeons demonstrated the highest level of agreement using both classification systems. For individual questions, the addition of CT did significantly improve reviewer interpretation of fracture stability. The pre-CT and post-CT Kappa values for fracture stability were 0.59 and 0.93, respectively. CONCLUSIONS: The CT scan can improve the reliability of assessment of pelvic stability because of its ability to identify anatomical features of injury. The Young-Burgess system may be optimal for the learning surgeon. The Tile classification system is more beneficial for specialists in pelvic and acetabular surgery.